Mossy leg with eccrine syringofibroadenomatous hyperplasia resembling multiple eccrine syringofibroadenoma

Cutaneous acantholytic dyskeratotic acanthoma accompanying syringofibroadenomatous hyperplasia with proliferation of mature sebocytes: A case report

Acantholytic dyskeratotic acanthoma is a rare variant of epidermal acanthoma. It has a flat, plaque-like structure and is characterized microscopically by acantholysis and dyskeratosis. Eccrine syringofibroadenomatous hyperplasia is benign and likely reactive. It has recently been considered as a hyperplastic process affecting the eccrine ducts rather than the neoplasm because of its pathological heterogeneity and wide clinical associations. In this article, we present the case of 97-year-old Japanese women with a 10-mm wide, painful acantholytic dyskeratotic acanthoma accompanied by syringofibroadenomatous hyperplasia in the right femoral region. Although syringofibroadenomatous hyperplasia is known to occur as a reactive process with various dermatoses and cutaneous tumors, to date, there have been no reports of cases of acantholytic dyskeratotic acanthoma accompanying syringofibroadenomatous hyperplasia. Moreover, this case also includes the unusual finding of an increase in the mature sebocytes in the area of the syringofibroadenomatous hyperplasia.

Syringocystadenocarcinoma Papilliferum In Situ-Like Changes in Extramammary Paget Disease: A Report of 11 Cases

The authors report 11 cases of extramammary Paget disease (EMPD), all of which also demonstrated a combination of histological changes highly reminiscent of syringocystadenocarcinoma papilliferum in situ. In addition to the classical features of EMPD, characterized by the intraepidermal spread of individually dispersed neoplastic cells with ample cytoplasm, many of which contained mucin, there were areas of acanthosis with the substitution of spinous layer keratinocytes by neoplastic cells, whereas the native basal cell layer was intact. In addition to acanthosis (and sometimes papillomatosis), the dermal papillae showed a prominent infiltrate of plasma cells, completing the resemblance to syringocystadenocarcinoma papilliferum in situ; this similarity was further enhanced in 2 cases, which showed conspicuous gland formation. One additional case showed multifocal dermal proliferations compatible with eccrine syringofibroadenoma (syringofibroadenomatous hyperplasia). The changes described herein seem to be relatively rare in EMPD, and they can represent a diagnostic pitfall, as evidenced by 2 cases that were originally misinterpreted as syringocystadenocarcinoma papilliferum in situ. Clinically, these microscopic changes sometimes corresponded to nodular lesions, which were specifically noted to have a papillated erosive surface.

Multiple Eccrine Syringofibroadenoma of Mascaro of the Lower Extremity

Eccrine syringofibroadenoma (ESFA) is a rare benign lesion of ductal and secretory differentiation exhibiting multiple cutaneous polymorphic presentations with an unknown etiology. We present a case of ESFA that uniquely exhibited large, thick, verrucous-like hyperplastic growths as well as superficial shiny mosaic plaques and deep ulcerations in three different anatomical locations in the same patient. The diagnosis of ESFA was confirmed histologically after biopsies were performed on all of the affected areas. In addition to a case report and literature review, we also present classification, clinical, and histologic aspects of ESFA.

Histopathological and immunohistochemical features of nodular podoconiosis

BACKGROUND

Podoconiosis is a familial geochemical dermatosis which is common in Ethiopia but relatively unknown in Europe/United States. It is related to exposure of bare feet to volcanic soil and presents with extensive bilateral lymphedema of legs and feet. Histopathological and immunohistochemical features of it have not been described yet.

OBJECTIVES

The objectives of this study are to characterize podoconiosis histopathologically and immunohistochemically and to increase awareness of the disease.

METHODS

Ten specimens of fully developed podoconiosis were examined with hematoxylin/eosin, periodic acid-Schiff, Gram, elastica-van Gieson stainings, with immunohistochemistry (CD3,CD20,CD31,CD68,CD138, tryptase, podoplanin, collagen IV), and with polymerase chain reaction (PCR) for human papillomavirus (HPV)-specific DNA.

RESULTS

All specimens showed verrucous acanthosis and papillomatosis. Eccrine ducts demonstrated hyperplasia, syringofibroadenomatous changes and miliaria. Dermal collagen bundles were thickened, and elastic fibers were dramatically reduced. A moderate lymphoplasmacytic infiltrate was joined by mast cells and scattered macrophages; neutrophils and eosinophils were sparse. Blood vessels were increased, dilated, and often sclerotic while lymphatics were reduced and largely not dilated. HPV-PCR was negative in all specimens.

CONCLUSIONS

Podoconiosis demonstrates distinctive changes of chronic lymphedema with extensive sclerosis, loss of elastic fibers, verrucous acanthosis (not HPV induced) and reactive changes of eccrine structures. Mast cells, macrophages and altered blood vessels may be involved in the pathogenesis.

Eccrine syringofibroadenoma radiation treatment of an unusual presentation

Benign skin diseases have seldom been treated with radiotherapy, unless resistant to other treatments. Eccrine syringofibroadenoma (ESFA) is a rare benign eccrine tumor. ESFA very rarely presents bilateral lesions, and seldom a nonsurgical treatment has been proposed. An exceptional case of bilateral ESFA of the foot is presented; radiotherapy was effective in treating both lesions with good cosmetic results.

Characterizing the nature of eccrine syringofibroadenoma: illustration with a case showing spontaneous involution

Eccrine syringofibroadenoma (ESFA) is a histological entity. It has been widely debated as to whether ESFA is a true neoplasm, a hamartoma or a form of reactive hyperplasia. ESFA should not be considered a homogenous condition and there are five clinical subtypes: (i) multiple ESFA associated with ectodermal dysplasia, (ii) multiple ESFA without cutaneous features (both hamartomatous), (iii) unilateral linear ESFA (naevoid), (iv) solitary ESFA (neoplastic) and (v) reactive ESFA, which seems to start off as pathologically hyperplastic and then become hamartomatous. We report a patient with reactive ESFA secondary to lepromatous leprosy, showing spontaneous involution in an area of her lesions. Reactive ESFA represents a hyperplastic and hamartomatous process, and may be more appropriately known as reactive eccrine syringofibroadenomatosis. The risk of malignancy is low in reactive ESFA, and monitoring instead of excision is a reasonable option.

Eccrine Syringofibroadenoma of Clear Cell Variant

Eccrine syringofibroadenoma is a rare eccrine tumor first described by Mascaro in 1963. The clear cell variant was reported by Fretzin in 1995. We describe a hemorrhagic papule on the knee of a 64-year-old woman. Microscopic examination revealed epidermal-based anastomosing thin epithelial cords with ductal structures surrounded by a fibrovascular stroma. Multiple nests of glycogen-containing clear cells were also present. The tumor cells forming the epithelial cords expressed keratin. The eccrine ductal structures and clear cells additionally expressed gross cystic disease fluid protein-15 (GCDFP-15). Reactivity with antibodies against estrogen receptor or progesterone receptor was negative. These results favor the dual differentiation of the clear cell variant of eccrine syringofibroadenoma toward ductal and secretory portions of the eccrine sweat gland.

An unusual melanocytic lesion associated with eccrine duct fibroadenomatosis and syringoid features

The intimate association of nevomelanocytic nevi with eccrine ducts commonly seen in congenital nevi was emphasized by Mishima, who described as eccrine-centered nevi those lesions characterized by nevomelanocytic cells predominantly proliferating around and within the eccrine sweat duct walls. However, there were no changes in the overlying epidermis, dermis, or eccrine acrosyringeal or dermal duct proliferation in these lesions. We present the case of a 16-year-old boy with a 1-year-history of a 0.6-cm diameter single tan papule on the right heel, clinically thought to be a Spitz nevus. Histopathologic examination revealed a compound nevomelanocytic nevus associated with epidermal hyperplasia, thin anastomosing cords of acrosyringeal epithelium extending within the dermis, and eccrine ductal proliferation in a syringoma-like pattern associated with a dense fibrous stroma. Features that distinguish our case from eccrine-centered nevus are that the latter lacks epidermal and eccrine duct hyperplasia and a dense fibrous stroma. The location of the lesion on the heel in our case suggests the possibility that the pathologic changes observed could result from repetitive trauma.

Eccrine syringofibroadenoma in a patient with a burn scar ulcer

A 72-year-old woman with a burn scar on the calves of both legs developed an ulcer on her right heel, surrounded by multiple verrucous nodules and plaques. She had experienced similar verrucous lesions on both legs in the burn scar areas. Although the clinical diagnosis was Marjolin's ulcer, histologically the ulcer region showed thick fibrous tissue without any atypical epithelial cells. The verrucous lesions were consistent with the diagnosis of eccrine syringofibroadenoma (ESFA). Moreover, an ESFA-like growth pattern was seen in the elevated margin of the ulcer. Our findings suggest that these lesions developed as a result of reactive eccrine duct hyperplasia followed by skin tissue remodelling.

Proliferation of eccrine sweat ducts associated with heterotopic neural tissue (nasal glioma)

The term "nasal glioma" refers to the presence of heterotopic neural tissue, mainly glial in nature, at or near the root of the nose. We describe a case in which all three components of neural tissue, that is, leptomeninges, glia, and neurons, were present, associated with sweat-duct hyperplasia. Proliferation of sweat ducts is a reactive process in some benign and malignant neoplasms, hamartomas, and cysts. This is the first documented case of hyperplasia of eccrine ductal epithelium induced by nasal glioma.

Plantar hyperkeratosis due to Fusarium verticillioides in a patient with malignancy

We report the case of an 82-year-old man with hyperkeratosis of the right sole caused by a Fusarium verticillioides infection mimicking verrucous tuberculosis; the infection was confirmed by direct potassium hydroxide microscopy, biopsy and cultures. The biopsy specimen showed an unusually deep invasion of fungal elements into the epidermis. This is an uncommon presentation in a localized cutaneous infection by Fusarium but in this case, repeated local injuries were the portal of entry initiating the process. Clinical patterns of cutaneous fusarium infections in general are also discussed.